By Dr Jay Desai
The World Health Organization estimates that more than 450 million people across the globe suffer from mental disorders. Although 10 October is celebrated as the World Mental Health Day for more than two decades now, a lot remains to be done for those who suffer from such conditions. Despite the awareness, patients of psychiatric illnesses continue to be marginalised, do not receive the attention they deserve and are often the subject of ridicule. There are perhaps two fundamental reasons why this has come to be.
First, the disorders of human brain represent the final frontier in medicine. While medical researchers and clinicians have achieved significant success in understanding and treating diseases that affect the heart, the lungs, the liver or the kidneys; those that affect the human brain are comparatively poorly understood. The lack of understanding thereby leads to some of the stigma associated with mental disorders.
Second, a division of disorders of the human brain into ‘functional’ and ‘organic’ categories over the years has had a negative impact upon the way mental illness is perceived today. Perhaps, the medical fraternity is to blame for this artificial division. The brain is the only organ in the human body which receives the attention of two separate groups of medical specialists – the psychiatrists and the neurologists. While the psychiatrists are supposedly the specialists for ‘functional’ disorders of the brain, the neurologists are called upon to treat ‘organic’ or ‘biologic’ brain diseases. This arbitrary compartmentalisation has led to a general belief that neurological diseases such as stroke, multiple sclerosis and Parkinson’s disease are ‘real’ but mental health disorders are not.
This is certainly not true. A majority of psychiatric illnesses are hypothesised to have biologic bases. Depression is the most common mental health disorder and low levels of serotonin (a chemical neurotransmitter in the human brain) are thought to be, at least, partly responsible for its causation. Schizophrenia is another well known mental illness that is thought to be caused due to abnormalities involving other neurotransmitters, namely dopamine and glutamate. In recent years, specialised techniques in the field of functional imaging have given us visual evidence of changes in the brain in this disease. Biological bases of anxiety disorders such as obsessive-compulsive disorder and panic disorders are being better understood in recent times as well.
Let us examine a brain disorder to understand how complete the dichotomy of the fields of psychiatry and neurology is. Encephalitis (inflammation of the brain) results from a variety of causes including for example a viral infection. When this inflammation affects the motor strip (a part of the brain responsible for giving commands for bodily movements), it results in paralysis and the neurologists are called upon. If the inflammation in the same patient affects a contiguous structure of the brain responsible for higher cognitive function leading to delirium, the psychiatrists step in.
In many diseases, there is a considerable overlap of ‘neurological’ and ‘psychiatric’ symptoms such as in epilepsy, but again the biological basis of this disease is obvious and well researched. Moreover, in the 21st Century, we are discovering treatable ‘neurological’ diseases that manifest with predominantly ‘psychiatric’ symptoms. In retrospect, these diseases were possibly condemned as mental illnesses earlier and these patients were erroneously sent to the mental asylums. One such disease is the anti-NMDA (N-methyl D-aspartate) receptor encephalitis that has been recognised as late as in 2007. This disease often initially manifests as sexual dis-inhibition and psychosis and comes to the attention of the psychiatrist as a ‘functional’ disorder. These manifestations are due to an inflammation of a part of the brain that controls emotions and sexual behaviour. The inflammation is often a result of our body’s immune response to fight a tumor outside the brain. As you would have guessed, the neurologists ultimately treat this disease once the ‘organic’ diagnosis is established.
A majority of human diseases are caused due to interplay of genetic and environmental influences and have some biological bases. Although this is oversimplification to an extent, it explains most infirmities – from diabetes to coronary heart disease. Mental health disorders are no exceptions.
The 1990s were nominated to be the decade of the brain to stimulate scientific advances in the field. However, we have a long way to go before we fully understand the brain and its diseases. The need of the hour is to remove the stigma associated with mental illnesses. Since many of these are easily treatable (and tremendously disruptive if not treated), we need to foster confidence to encourage families to come forward early upon recognition of symptoms to seek help without fear of being stigmatised. Finally, we need strategies to assimilate those who are not completely controlled under treatment in our society.
(The author is a diplomate of American Board of Psychiatry and Neurology and a faculty at University of Southern California Keck School of Medicine)
